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Tan C, Ofner M, Candon HL, Reel K, Bean S, Chan AK, Leis JA. An ethical framework adapted for infection prevention and control. Infect Control Hosp Epidemiol 2023; 44:2044-2049. [PMID: 37424230 PMCID: PMC10755160 DOI: 10.1017/ice.2023.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The ethical implications of infection prevention and control (IPAC) are recognized, yet a framework to guide the application of ethical principles is lacking. We adapted an ethical framework to provide a systematic approach for fair and transparent IPAC decision making. METHODS We conducted a literature search for existing ethical frameworks in IPAC. Working with practicing healthcare ethicists, an existing ethical framework was adapted for use in IPAC. Indications were developed for application to practice, with integration of ethical principles and process conditions specifically relevant to IPAC. Practical refinements were made to the framework based on end-user feedback and application to 2 real-world situations. RESULTS In total, 7 articles were identified that discussed ethical principles within IPAC, but none proposed a systematic framework to guide ethical decision making. The adapted framework, named the Ethical Infection Prevention and Control (EIPAC) framework, takes the user through 4 intuitive and actionable steps, centering key ethical principles that facilitate reasoned and just decision making. In applying the EIPAC framework to practice, weighing the predefined ethical principles in different scenarios was a challenge. Although no hierarchy of principles can apply to all contexts in IPAC, our experience highlighted that the equitable distribution of benefits and burdens, and the proportional impacts of options under review, are particularly important considerations for IPAC. CONCLUSIONS The EIPAC framework can serve as an actionable ethical principles-based decision-making tool for use by IPAC professionals encountering complex situations in any healthcare context.
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Affiliation(s)
- Charlie Tan
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marianna Ofner
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Heather L. Candon
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Reel
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Ontario, Canada
| | - Sally Bean
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne K. Chan
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jerome A. Leis
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Porras-Povedano M, Santacruz-Hamer V, Muñoz-Collado E, Ramírez-Pulido R. [Ethical aspects of specific precautions programs in patients infected or colonised by multidrug-resistant microorganisms in a hospital setting]. J Healthc Qual Res 2020; 35:159-165. [PMID: 32404291 DOI: 10.1016/j.jhqr.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/28/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
The approach to public health, patient safety and quality of care has led to analysing health situations or problems from a population perspective, in a wide way and giving priority to factors that can normally be left in the background from a clinical point of view. For years, the problem of the use and abuse of antimicrobials, the increase and diffusion of microorganisms resistant to them, cross-transmission, and healthcare related infections have been prioritised both nationally and internationally. To combat these problems, various strategies are being developed and put into practice, from the policies of rational use and optimization of antimicrobials, surveillance, and control of infections related to health care, to training information and awareness strategies. One of the pillars of surveillance and control is the correct application of standard and specific precautions, which within the framework of these comprehensive programs aim to control the transmission of microorganisms of special microbiological and/or epidemiological interest through a series of measures. In hospitals, the application of these precautions (single room, barrier measures, restrictions on access to rooms, waste management…) in patients infected or colonised by these microorganisms can have different repercussions, both for patients and the professionals that attend them, and it is considered pertinent that the protocols and/or programs of specific precautions explicitly include the analysis of the ethical aspects in their preparation, implementation, and monitoring.
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Richards CL. Preventing antimicrobial-resistant bacterial infections among older adults in long-term care facilities. J Am Med Dir Assoc 2006; 7:S89-96, 88. [PMID: 16500292 DOI: 10.1016/j.jamda.2005.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For older adults in long-term care facilities (LTCFs), the rate of infections caused by antimicrobial resistant strains of bacteria has increased and is prompting renewed interest in investing health care resources for prevention and control of these pathogens. This document offers a simple framework to combat infections due to antimicrobial resistant bacteria in LTCF residents by providing a multi-step approach consisting of four major strategies: prevent infection, diagnose and treat infection effectively, use antimicrobials wisely, and prevent transmission. Recommendations from this multi-step approach are directed at LTCF medical directors and practicing clinicians involved with the medical care of older adult LTCF residents.
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Affiliation(s)
- Chesley L Richards
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Richards CL. Preventing antimicrobial-resistant bacterial infections among older adults in long-term care facilities. J Am Med Dir Assoc 2005; 6:144-51. [PMID: 15871891 DOI: 10.1016/j.jamda.2005.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For older adults in long-term care facilities (LTCFs), the rate of infections caused by antimicrobial resistant strains of bacteria has increased and is prompting renewed interest in investing health care resources for prevention and control of these pathogens. This document offers a simple framework to combat infections due to antimicrobial resistant bacteria in LTCF residents by providing a multi-step approach consisting of four major strategies: prevent infection, diagnose and treat infection effectively, use antimicrobials wisely, and prevent transmission. Recommendations from this multi-step approach are directed at LTCF medical directors and practicing clinicians involved with the medical care of older adult LTCF residents.
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Affiliation(s)
- Chesley L Richards
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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